Changing our mind with final consequences

This post was written a couple of months ago but scheduled for the end of November. Recent developments in Canada have caused me to publish it now.

I’ve seen a few of those lengthy on-line advertisements promoting a wonder drug, somewhat like the traveling medicine shows of the old west, wanting to part us with our money.  The internet versions typically are lengthy commercials that use suspenseful delay (drawing in the viewer by not clearly saying what they’re selling until near the end), so that a sympathetic back-story can be shown and have the viewer identify with symptoms of suffering citizens. Finally, after more ploys and gimmicks, we find out the ad wants to sell us bottles of pills and it claims indispensable uniqueness (why their pills are the only product of its kind, available only from them). Step by step, people get hooked.

But this post is not about such clever ads but about changes in our outlook on various social issues. I don’t believe there is a grand advertising conspiracy behind those, and yet there are certain familiar patterns. There is usually at first no talk of a sweeping change, and instead the nation’s interest is aroused by a few specific instances of people suffering, so…. “Shouldn’t something be done about that?”  Most reasonable people then think, “Yes, that’s terrible, something must be done.”  Eventually enough of society’s resistance to change is overcome, and attitudes or laws begin to reflect that. But then ….

But then there are further developments that push the envelope.   The change needs to be extended, they say. And again, it sounds like a reasonable request that may sit well with many people, but hostile labels start being used against concerned people who urge caution, and that is a form of intimidation; nobody wants to be prejudged by a label.

In the world of commercial advertising we would call this “Bait-and-switch”:  get someone to agree to something, but then switch the discussion to the real point of the sales talk, which is to sell something more costly or longer term.  However, with social issues it is not always quite so crass, as there is some public debate and differing positions are sincerely held by many in the population as they think these matters through. Yet there has been in such matters a push toward greater far-reaching change, which may have larger consequences than what society had bargained for.

In my own career, I have often been involved in the issue of suicide and have trained many people in suicide prevention, with the emphasis on significant support for the suicidal person.  On the other hand, I have also sat at the bedside of a person dying in a hospital whose doctors have had to stop feeding in order to let nature take its course, or where the machines that were keeping a person barely alive were about to be shut off.  The matter of a person’s death is rarely a simple concern, and it requires of us some deeper thinking.

Euthanasia, the active medical chemical procedure to bring about death, is increasingly common in many countries, and one of the more permissive countries in this regard is Canada, where it is called MAiD (Medical Assistance in Dying).  In 2016, a federal law changed the legal criteria for euthanasia from a terminal illness to any condition in which natural death was “reasonably foreseen,”  thus opening the door a little wider; and then in March of 2021 a new law for MAiD was passed that no longer requires natural death to be reasonably foreseen!

This means that though medical permission is still required, it is the patient, not the doctor, who ultimately decides whether the condition is “intolerable or untreatable.”  Some cautions and limits remain in place, but federal attorney general David Lametti in 2020 already indicated that the next step would be to open the doors of euthanasia to psychiatric patients.

On that latter issue, the Canadian Psychiatric Association, a body which had been following its American cousin organization, the APA, in stating “…a psychiatrist should not prescribe or administer any intervention to a NON-terminally ill person for the purpose of causing death,” has now, however, made the following remarkable statement in regard to medically assisted suicide: “Patients with a psychiatric illness should not be discriminated against solely on the basis of their disability….”  (italics in the quote are mine). The issue of human suffering and euthanasia is difficult, but re-branding it this way as a matter of social stigma and civil rights seems to short-cut the debate away from other ethical considerations. 

Just last week, Louis Roy of the Quebec College of Physicians said they are “researching” the possibility of extending MAiD to “babies …. and to elders who are sliding into emptiness.” Assisted suicide is gradually coming to be seen as best-practice health care and as a government-funded legal right — and that while alternative options and supports go begging. One study showed that palliative “end of life” care and personal support is not publicly funded in much of the country and that Canadian “palliative care stakeholders are working in isolation.”   Some human rights advocates say Canada’s euthanasia policies “devalue the lives of disabled people” and that the policies “are prompting doctors and health workers to suggest the procedure to those who might not otherwise consider it.”

You may have heard of the widely-publicized case of a government worker who strongly suggested suicide to an unwilling veteran with mental health issues, and though that worker has been reprimanded, it raises the question of how easily assisted-death is coming to be viewed as an option that is equal to, or even preferable to, adequate and funded supports. (Further on this in the next post on Friday.)

References:

Title photo: Canadian Centre for Policy Alternatives, 2012 Calendar

“Disturbing,” Associated Press release on Canada’a euthanasia laws, New York Post, September 1, 2022

“Get the facts: Canada’s medical assistance in dying (MAID) law… your right to a peaceful death.”  On-line organ of Dying with Dignity Canada, accessed August 2022

“Palliative Care Stakeholders in Canada,” a study by Jingjie Xiao et al., University of Alberta.

Professional biography of Dr. Mark S. Komrad, Journal of Ethics in Mental Health, Volume 10, 2017

—- “Assisted Suicide and Euthanasia of Patients with Mental Disorders,” by Dr. Mark S.  Komrad, available on Youtube

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